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Included in the table below is a summary of the changes:

Cabinet for health and family services attendance confirmation rev 07/18 tris 1a page _____ of ______ Print your name and region and record daily hours in the daily boxes Record your total hours on the last day Day 1 day 2 day 3 day 4 day 5 day 6 total first name:

These forms should not be emailed as the form revised Please fax or mail them only